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O* 4R104, 11
CITY OF PRIOR LAKE • Date Rec'd
x HEATING/AIR CONDITIONING/FIREPLACE PERMIT
» m aJ?x,03
4,,.....,t. ,,,,,,,/ # oz- /2 43
Fink File PERMIT NO.,_
Green City
3. Yellow Applicant (�
(Please type or print and sign at bottom)
ADDRESS ZONING(rice use)
4/6 f1 . 79,„,a6--r-,(2re,
,,
LEGAL DESCRIPTION(office use only)
LOT BLOCK 0—ADDITION 4,1,/,f�e ,-1.-- 0' /j'�ID 5
h -39/--G05-10
dl R //e.Gr +O/'4' (Phone)
(Address)
lotiorMaTit i r
( S -ss r)c,-....re' /ileel..w..4_.'t 4 / diliPe ` — 46a-40.16-670‘..
1a57 rLtck.lac_�.....c at sc.«(� t .- ...575-37<1
001- (tea-.
(600fect Yerson) IS*s (-foo v t d'` (Phone) Q 5a-q q --.Sla4)
N.
AP 0-c:77-03
APPLICANT PLEASE COMPLETE BELOW
NEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants 0 Steam PLEASE NOTE:
❑Gravity ❑Hot Water Air Conditioner Units
Mechanical ❑Radiation Cannot Encroach into
Air Conditioning
0 Special Devices Required Side Yard
Vent.System 0 Other Devices Setbacks
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial,Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace $39.50
$39.50 minimum
Residential,Heating&A/C(New Construction) $99.50 Residential,Additions&Alterations $39.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $39.50
Estimated Cost$ c:96-.6-‘200 Building Permit # 63'b 12
HEATING PERMIT FEE $ 2S5C
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ -7-S5-O SO
(Office Use 0 0/GLa2 ¢,3,0-3
This ' • • k to , .ies ' • Buildin rmit When Approved Pai �
d ReceiptN3990
-,,/ .414.t 4 f b 3 Dat �1 By cia
Buil''n l i` cial Date - '6(? -
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
16200 Eagle Creek Avenue,Prior Lake,MN 55372